A hospital requires numerous protective measures to ensure the control of germs and bacteria. Healthcare professionals establish protocol to ensure a sanitary environment for patients and healthcare providers. Patient isolation is one such practice. This procedure can become time-consuming and cumbersome depending on the number of patients, frequency of visits, and whether or not the hospital's facilities easily accommodate the procedure.
Patient isolation practices are essential for controlling the spread of infections in hospitals. The Center for Disease Control and Prevention (CDC) and the Hospital Infection Control Practices Advisory Committee (HIPAC) developed and revised a “Guideline for Isolation Precautions in Hospitals” to promote up-to-date isolation practices in hospitals. In addition to CDC and HICPAC Guideline, the Occupational Safety and Health Administration (OSHA) has issued a rule mandating the use of specific protective wear to reduce the risk of exposure to certain pathogens.
The Guideline for isolation precautions, under the CDC, is designed to reduce the risk of pathogen transmission in hospitals between patients, healthcare workers, visitors, and environmental objects. Nosocomial infection transmission requires a source of infecting microorganisms, a susceptible host, and a means of transmitting the microorganism. Sources include patients, personnel, visitors, in varying stages of the disease from acute sufferers to chronic carriers, and contaminated inanimate objects, such as equipment, medications, and supplies. Patient factors such as age, underlying disease, treatments, irradiation, and interruptions in the first line of defense mechanisms affect susceptibility to infections. Transmission of microorganisms, under the Guideline is divided into several categories: contact, droplet, airborne, common vehicle, and vectorborne. Methods of a microorganism's transmission affect how the microorganism is isolated. However, hospital's use certain basic isolation requirements for all isolated patients regardless of transmission route.
According to the CDC Guideline, contact is the most frequent transmission means. Direct-contact transmission occurs between two body surfaces, a susceptible host and an infected or colonized person. Indirect-contact transmission occurs via a contaminated intermediate object, such as instruments, needles, dressings, or supply stations. Another source of indirect-contact transmission is hands that are not washed and gloves that were not changed between patients.
Two other important routes of transmission are droplet and airborne transmission. Droplet transmission occurs when the source coughs, sneezes, talks, and during some treatment procedures which suspend droplets in the air for a short distance. Such short distances differentiate the droplet transmission from airborne transmission that occurs when very small-evaporated droplets or dust particles remain suspended in the air for long period of time.
As mentioned, hospitals design isolation protocol to prevent the spread of microorganisms. Isolation creates a barrier to disrupt pathogen transmission between sources and hosts. Barriers created decrease the opportunity for the harmful bacteria or germs to spread from one patient to another or from a patient to a healthcare provider. While isolation measures often depend on a patient's infection and/or condition, there are certain universal measures used for all isolated patients and certain measures used for every patient where there is potential for contact with bodily fluids. Precautions include hand washing, gloving, and strategic patient placement. For activities that may result in contact with certain body fluids, precautions may include masks, respiratory protection, eye protection, face shields, gowns, protective apparel, and patient-care equipment articles.
While isolation precautions are essential to controlling the spread of infections and diseases, there are costs to isolation procedures. Certain isolation precautions require environmental modifications, specialized equipment and procedures that may make patient visits inconvenient and time-consuming. The hurdles imposed by isolation protocol, may negatively affect a patient's treatment.
Research suggests that patient isolation frustrates a healthcare worker's ability to examine patients because of the additional effort required to gown and glove. The additional prep time before a patient visit can cause problems if a patient requires prompt care. The isolation precautions can also become an obstruction to ordinary care received by the patient. Therefore, making isolation practices easy to implement is important.
As stated, the prep routine completed by healthcare providers before visiting patients can consume unnecessary time. Before visiting isolated patients, attending healthcare providers must sanitize their hands, put on gloves, a gown, or apron (if there will be substantial contact with the patient, or patient's environment) and possibly a mask. Other required protocol may follow, depending on the transmission route of the pathogens. Gloves must be changed between tasks and procedures on the same patient, if the healthcare provider touches material possibly containing a high concentration of microorganisms. After the patient visit, the physician, nurse, or other healthcare provider must remove gloves and gowns as promptly as possible and then sanitize his or her hands.
Location of the items used for isolation procedures is extremely important. These procedures become more time-consuming when the needed equipment and supplies are difficult to find or manipulate. Such equipment and supplies should remain conveniently located near the patient and systematically organized. Further, since patient placement is an important component of isolation protocol, the isolation supplies such as gloves, masks, eye protection, gowns, and other equipment should be easily movable with the patient.
Hospitals want to ensure that the transmissions of infection causing pathogens are controlled while not unnecessarily interfering with patient care. However, current isolation practices often interfere because they are frustrating, confusing, and time-consuming. This is a result of the disorganized manner in which isolation tools, equipment, and supplies are kept. Throughout many hospitals medical carts used for isolation procedures are cluttered, disorganized, and crowded with cups, boxes of gloves and gowns, three-ring binders, papers, medical instruments, such as stethoscopes, and lab coats. Other bare-boned shelves used for isolation procedures may house only a box of gloves and a few hospital gowns. Many times the gloves, gowns, masks, or other protective supplies are not stocked at the isolation area, and this is only discovered after the station has been searched for the required items in times of urgent need. Even if the required supplies can eventually be found amidst the clutter, the disorganization eats into precious time and frustrates healthcare workers.
The search for needed supplies not only frustrates the healthcare provider, but also frustrates the primary goal of isolation precautions, to stop transmission of pathogens. During the search for the required tools and supplies, a healthcare provider unnecessarily touches environmental surfaces and inanimate objects that have a risk of contamination, thereby increasing the opportunity for pathogen transmission. Thus, systematically organizing the supplies not only decreases the interference that isolation precautions cause, but by making the preparation routine touch-free, the primary goal of the procedure, to stop germ and bacteria transmission, is enhanced. Aseptic procedures are important in an environment where the risk of infection is high. Decreasing the unnecessary handling and manipulation of equipment and supplies will assist hospitals in providing a sanitary environment.
Accordingly, there is a need for an improved cart for organizing, standardizing, and centralizing the equipment and supplies required for isolation procedures.